The Feasibility Of Coronary Artery Disease From Proximal To Disal Implantation

Objective : To study the feasibility of interventional therapy for coronary artery disease from near to far stent implantation.Methods: Retrospective analysis was performed on 530 cases of coronary interventional surgery under the guidance of coronary angiography in the heping district of the northern theater hospital from March 2015 to June 2018.The same lesion were selected and divided into 15 experimental groups according to the way of stent implantation,that is,stents were implanted in sequence from proximal to distal.in the control group,33 cases were treated with distal to proximal stent implantation.The immediate effect of multi-angle coronary angiography review after operation and postoperative short-term(hospitalization)adverse cardiovascular events,such as the number of angina attacks,the incident of adverse cardiovascular events such as cardiac death,recurrent myocardial infarction,severe arrhythmia,new or increased heart failure and angina symptoms were compared between the two groups.Result : 1.Review of immediate coronary angiography results: the control group(using reverse stent implantation technique),all cases were successfully completed PCI operation,immediately after the review of coronary angiography showed that the stent was fully expanded,fully attached,TIMI3,no thrombus,interlayer,stent implantation effect is good.The experimental group(using the directional stent implantation technique)successfully completed the PCI operation in all cases.Immediately after the examination,the coronary angiography showed that the stent was fully expanded,the adherence was complete,TIMI grade 3,no thrombus and dissection,and the stent implantation effect was good.(1)All cases successfully completed PCI operation by reverse stent implantation,postoperative immediate review coronary angiography,stent expansion satisfaction,stent residual stenosis less than ten percent,without interlayer,acute thrombosis,TIMI3 level,and return to observe without intervention complications after wards.All cases with forward stent implantation successfully completed PCI operation,postoperative immediate review coronary angiography,stent expansion satisfaction,stent residual stenosis less than ten percent,without interlayer,acute thrombosis,TIMI3 level,and return to observe without intervention complications after wards.(2)Compare with the short-term Major adverse cardiac events: During the period of hospitalization,no postoperative cardiac death or recurrence of myocardial infarction occurred in either the experimental group or control group.In the experimental group,5 cases of postoperative recurrence of angina,6 cases of postoperative severe arrhythmia,2 cases of new or aggravated heart failure.In the control group,6 cases of postoperative recurrence of angina,1 case of postoperative severe arrhythmia occurred.There was no significant difference in the number of postoperative angina pectoris and new or aggravated heart failure between the two groups(P>0.05).There was a statistically significant difference between the experimental group and the control group(40% vs 6%,P < 0.05).Conlusion: During percutaneous coronary intervention,the following conditions may be encountered: 1.Long,tortuous,severe calcification;2.Dissection of the distal end of the lesion or distal to the lesion after implantation;3.Critical condition,Hemodynamic instability,etc.,need to quickly open the proximal blood flow.Blood flow can be improved by implanting the proximal end of the lesion into the distal end(the technique of antegrade stent implantation).The study shows that the technique can obtain better immediate imaging results,shorten the operation time of the operation,and improve the operation of complex lesions.Success rate;cis-stent implantation technique has no significant effect on angina pectoris,new or aggravated heart failure after PCI? Whether it has a significant impact on the occurrence of severe arrhythmia after surgery,continue to explore in the future.